<extend name="Public:base" />


<block name="nav"></block>


<block name="main">

<div class="block">

<div class="fr mr10">
	<a href="javascript:history.back();"><i class="icon-reply"></i> 返回</a>
</div>

<div class="title">考试报名</div>

<div class="p10 lh150 tline bccc ld">

<br>

<form id="form" action="" method="post" class="form-horizontal">

	<div class="form-group">
		<label class="col-sm-3 control-label">日期
		<span class="red">*</span></label>
		<div class="col-sm-9">
			<label><input type="radio" name="date" checked> 2015-04-01 星期三</label><br>
			<label><input type="radio" name="date"> 2015-05-01 星期五</label><br>
			<label><input type="radio" name="date"> 2015-06-01 星期一</label><br>
		</div>
	</div>

	<div class="form-group">
		<label class="col-sm-3 control-label">姓名
		<span class="red">*</span></label>
		<div class="col-sm-9">
			<input name="id" value="李乐思" class="form-control">
		</div>
	</div>

	<div class="form-group">
		<label class="col-sm-3 control-label">联系电话
		<span class="red">*</span></label>
		<div class="col-sm-9">
			<input name="id" value="18012345678" class="form-control">
		</div>
	</div>

	<div class="form-group">
		<label class="col-sm-3 control-label">留言</label>
		<div class="col-sm-9">
			<textarea name="id" class="form-control">考试内容是什么，有没有复习题刚</textarea>
		</div>
	</div>

	<div class="form-group">
		<div class="col-sm-offset-3 col-sm-9">

			<button class="btn btn-sm btn-primary">提交</button>

		</div>
	</div>
</form>

</div>

</div>


</block>
